Cognitive, physical and emotional determinants of activities of daily living in nursing home residents-a cross-sectional study within the PROCARE-project

BACKGROUND

Interdependencies of health, fitness, cognition, and emotion can promote or inhibit mobility. This study aimed to analyse pathways and interactions between individual subjective and objective physical performance, cognition, and emotions with activities of daily living (ADLs) as mobility indicators in multimorbid nursing home residents.

METHODS

The study included n = 448 (77.1% females, age = 84.1 ± 7.8 years) nursing home residents. To describe the participant's demographics, frailty, number of falls, and participating institutions' socioeconomic status (SES) were assessed. ADLs were measured with the Barthel Index (BI; dependent variable). Independent variables included objective physical performance, subjective physical performance, cognition, and emotions. A structural equation model (SEM) with maximum likelihood estimation was conducted with AMOS. Direct and indirect effects were estimated using standardized coefficients (significance level of 0.05).

RESULTS

Indices showed (Chi2(148) = 217, PCMIN/DF = 1.47; p < .001; Comparative Fit Index = .940; Tucker Lewes Index = .902, RMSEA = .033) that the model fitted the data adequately. While there was no direct association between emotions, subjective physical performance, and ADLs, objective physical performance and cognition predicted higher ADLs (p < .01). Emotions had a strong relationship with subjective physical performance, and cognition had a moderate relationship with objective physical performance.

DISCUSSION AND CONCLUSION

Objective performance and cognition predicted higher functional status, as expressed by higher BI scores. ADLs, such as mobility, dressing, or handling tasks, require motor and cognitive performance. Subjective performance is an important predictor of ADLs and is only partly explained by objective performance, but to a large extent also by emotions. Therefore, future interventions for nursing home residents should take a holistic approach that focuses not only on promoting objective physical and cognitive performance but also on emotions and perceived physical performance.

TRIAL REGISTRATION

Trial registration number: DRKS00014957.

Role of age and sex in the association between BMI and functional limitations in stroke patients: Cross-sectional analysis in three European and US cohorts

BACKGROUND

A U- or J-shaped association between BMI and different post-stroke outcomes is suggested. Thus, the aim is to evaluate the association between BMI with ADL, IADL and mobility limitations in the ageing post-stroke population at different ages, as well as the differences in this association by sex.

METHODS

A total of 5,468 participants with stroke and 21,872 without stroke over 50 years of age were assessed for the number of limitations in basic or instrumental activities of daily living (ADL/IADL) as well as mobility tasks. The association between BMI at the interview (continuous time-dependent variable) and the level of limitations was assessed using a linear mixed model stratified by sex and stroke status.

RESULTS

The association between BMI and ADL/IADL and mobility limitations were found to be significant in both men and women regardless of stroke status (p<0.001 for all). The association differs between those who have suffered a stroke and those who have not (p<0.001 for all). In ADL/IADL limitations, men with stroke showed a transition from an inverted J-shape to a U-shape association with age. In women, the BMI showed a less pronounced association between BMI and ADL/IADL limitations compared to men but with similar trends. A effect of sex was observed in the association between BMI and mobility, with women with and without stroke showing a linear association that differed from the inverted J-shaped or U-shaped association of men.

CONCLUSION

Our results suggest that BMI is associated with limitations in ADL, IADL and mobility in stroke patients. In addition, this association differs between men and women and is also influenced by age.

The bidirectional relationship between depressive symptoms and functional limitations among centenarian survivors in their 80s: Testing bivariate latent change score models

OBJECTIVES

The purpose of the study was to examine a bivariate latent change score model of depressive symptoms and functional limitations (activities of daily living) among centenarian or near-centenarian survivors over four waves using the Health and Retirement Study.

METHOD

Four hundred and sixty participants who eventually survived to age 98 or older were included by calculating their death age. Data from the time when the participants were in their 80s were analyzed. The mean age at baseline (1994) was 85.5 years. The observation interval was 2 years, from 1994 to 2000. Including age, gender, and education as a covariate, eight different models were conducted to examine the bivariate effects among depressive symptoms and functional limitations.

RESULTS

Of the eight models, the bivariate model of depressive symptoms predicting change in functional limitations fitted the data best. The parameter estimates of the final model indicated significant predictive pathways from depressive symptoms to subsequent changes in depressive symptoms and functional limitations.

CONCLUSION

This study tested the bidirectional relationship between depressive symptoms and functional limitations among centenarian survivors in their 80s, which uncovered that depressive symptoms is a dominant variable among the two constructs. Our findings add to a lacking number of longitudinal studies with oldest old adults.

Muscle Endurance and Self-Perceived Fatigue Predict Decline in Gait Speed and Activities of Daily Living After 1-Year Follow-Up: Results From the BUTTERFLY Study

BACKGROUND

Fatigue might influence the losses in activities of daily living (ADL). When fatigue parameters are present before the experience of losses in ADL and gait speed, they can be used as early warning signals. This study aimed to explore the predictive value of muscle endurance and fatigue on changes in ADL and gait speed in community-dwelling older adults aged 80 and older.

METHODS

Three hundred twenty four community-dwelling older adults aged 80 and older of the BUTTERFLY study were assessed after 1 year for muscle endurance, self-perceived fatigue, ADL, and gait speed. Exploratory factor analysis (EFA) was performed to explore, whether there is an underlying arrangement of the fatigue parameters. Mediating logistic regression analyses were used to investigate whether muscle endurance mediated by self-perceived fatigue predicts the decline in gait speed and ADL after 1-year follow-up.

RESULTS

EFA indicated a 2-factor model (muscle endurance factor and self-perceived fatigue factor) and had a moderate fit (X2: 374.81, df: 2, comparative fit index; 0.710, Tucker-Lewis index (TLI): 0.961, root mean square error of approximation [90%]: 0.048 [0.00-0.90]). Muscle endurance mediated by self-perceived fatigue had an indirect effect on the prediction of decline in Basal-ADL (-0.27), Instrumental-ADL (-0.25), and gait speed (-0.28) after 1-year follow-up.

CONCLUSION

This study showed that low muscle endurance combined with high self-perceived fatigue can predict changes in ADL after 1-year follow-up. These parameters might be very suitable for use in evaluating intrinsic capacity and can help to reduce the limitations in clinical usage of the vitality domain in the framework of intrinsic capacity.

Reduced pain and improved daily activities for individuals with hand osteoarthritis using a silicone wrist hand orthosis

BACKGROUND

Symptoms of hand osteoarthritis (OA), such as pain, reduced grip strength, loss of range of motion (ROM) and joint stiffness, can lead to impaired hand function and difficulty with daily activities. Rehabilitative interventions with orthoses are commonly in the treatment of hand OA to reduce pain, improve hand strength and ROM, provide support for improved function and help with joint stability.

PURPOSE

The objectives of this perception-based study were to evaluate the effect of a silicone wrist hand orthoses (SWHO) on pain and daily functioning.

STUDY DESIGN

This study is a qualitative descriptive study. The patient received outcome (PRO) questions in the study were based on the Patient Rated Wrist and/or Hand Evaluation (PRWHE), a 15-item questionnaire designed to measure wrist pain and disability in activities of daily living.

METHODS

Patients with OA using a SWHO were asked to complete a questionnaire about the effectiveness of the brace after wearing it for 3 weeks. Primary outcome measure was general daily functioning with and without the use of the SWHO. Secondary outcome measures were change in pain symptoms and limitations for certain activities with and without the aid.

RESULTS

The results of this large-scale PROM study of 551 patients on the effectiveness of SWHOs in patients with hand OA show an improvement in overall daily functioning of 77% and a 61% reduction in perceived pain. This study adds to the evidence reported by systematic reviews of conservative interventions for hand OA and further quantifies the effects of a tailor made SWHO. This study confirms that wearing a wrist orthosis has a particularly significant impact on the execution of static and repetitive wrist-straining activities.

CONCLUSION

The study on the effectiveness of a SWHO in patients with hand OA shows that the use of a SWHO contributes to general daily function, reduces pain and increases the breadth of potential daily activities. This study shows that the use of a SWHO appears to offer pain relief and suitable support to the joint.

Comparison of caregiver burden between dementia with Lewy bodies and Alzheimer's disease

BACKGROUND

Caring for patients with dementia with Lewy bodies (DLB) would be more stressful for their caregivers than those with Alzheimer's disease (AD). In this study, we compared levels of caregiver burden and the possible influential factors on the caregiver burden between DLB and AD.

METHODS

Ninety-three DLB patients and 500 AD patients were selected from the Kumamoto University Dementia Registry. Caregiver burden, neuropsychiatric symptoms, basic activities of daily living (BADL) and instrumental activities of daily living (IADL) were assessed by the Japanese version of the Zarit Caregiver Burden Interview (J-ZBI), the Neuropsychiatric Inventory (NPI), the Physical Self-Maintenance Scale (PSMS), and the Lawton IADL scale, respectively.

RESULTS

Despite the comparable Mini-Mental State Examination score, the J-ZBI score was significantly higher in the DLB group than the AD group (P = 0.012). A stepwise multiple regression analysis revealed that IADL score (β = -0.23, P = 0.049), PSMS score (β = -0.31, P = 0.010), disinhibition (β = 0.22, P = 0.008), and anxiety (β = 0.19, P = 0.027) were significantly associated with J-ZBI score in DLB. In AD, caregiver's relationship with patient (child) (β = 0.104, P = 0.005), caregiver's gender (female) (β = 0.106, P = 0.004), IADL score (β = -0.237, P < 0.001), irritability (β = 0.183, P < 0.001), apathy (β = 0.132, P = 0.001), agitation (β = 0.118, P = 0.007), and aberrant motor behaviour (β = 0.107, P = 0.010) were associated with caregiver burden.

CONCLUSIONS

Caring for DLB patients caused a higher degree of caregiver burden than AD patients in the same level of cognitive decline. The factors responsible for the caregiver's burden were different between DLB and AD. The caregiver burden for DLB patients was associated with the disability of basic ADL, IADL impairment, anxiety and disinhibition.

Primary motor hand area corticospinal excitability indicates overall functional recovery after spinal cord injury

Background

After spinal cord injury (SCI), the excitability of the primary motor cortex (M1) lower extremity area decreases or disappears. A recent study reported that the M1 hand area of the SCI patient encodes the activity information of both the upper and lower extremities. However, the characteristics of the M1 hand area corticospinal excitability (CSE) changes after SCI and its correlation with extremities motor function are still unknown.

Methods

A retrospective study was conducted on the data of 347 SCI patients and 80 healthy controls on motor evoked potentials (MEP, reflection of CSE), extremity motor function, and activities of daily living (ADL) ability. Correlation analysis and multiple linear regression analysis were conducted to analyze the relationship between the degree of MEP hemispheric conversion and extremity motor function/ADL ability.

Results

The CSE of the dominant hemisphere M1 hand area decreased in SCI patients. In 0-6 m, AIS A grade, or non-cervical injury SCI patients, the degree of M1 hand area MEP hemispheric conversion was positively correlated with total motor score, lower extremity motor score (LEMS), and ADL ability. Multiple linear regression analysis further confirmed the contribution of MEP hemispheric conversion degree in ADL changes as an independent factor.

Conclusion

The closer the degree of M1 hand area MEP hemispheric conversion is to that of healthy controls, the better the extremity motor function/ADL ability patients achieve. Based on the law of this phenomenon, targeted intervention to regulate the excitability of bilateral M1 hand areas might be a novel strategy for SCI overall functional recovery.

Comparison of healthspan-related indicators between adults with and without HIV infection aged 18-59 in the United States: a secondary analysis of NAHNES 1999-March 2020

BACKGROUND

As persons with HIV (PWH) live longer they may experience a heightened burden of poor health. However, few studies have characterized the multi-dimentional health of PWH. Thus, we aimed to identify the extent and pattern of health disparities, both within HIV infection status and across age (or sex) specific groups.

METHODS

We used cross-sectional data from the US National Health and Nutrition Examination Survey, 1999-March 2020. The adjusted prevalence of six healthspan-related indicators-physical frailty, activities of daily living (ADL) disability, mobility disability, depression, multimorbidity, and all-cause death-was evaluated. Logistic regression and Cox proportional hazards analyses were used to investigate associations between HIV status and healthspan-related indicators, with adjustment for individual-level demographic characteristics and risk behaviors.

RESULTS

The analytic sample consisted of 33 200 adults (170 (0.51%) were PWH) aged 18-59 years in the United States. The mean (interquartile range) age was 35.1 (25.0-44.0) years, and 49.4% were male. PWH had higher adjusted prevalences for all of the 6 healthspan-related indicators, as compared to those without HIV, ranged from 17.4% (95% CI: 17.4%, 17.5%) vs. 2.7% (95%CI: 2.7%, 2.7%) for all-cause mortality, to 84.3% (95% CI: 84.0%, 84.5%) vs. 69.8% (95%CI: 69.7%, 69.8%) for mobility disability. While the prevalence difference was largest in ADL disability (23.4% (95% CI: 23.2%, 23.7%); P < 0.001), and least in multimorbidity (6.9% (95% CI: 6.8%, 7.0%); P < 0.001). Generally, the differences in prevalence by HIV status were greater in 50-59 years group than those in 18-29 group. Males with HIV suffered higher prevalence of depression and multimorbidity, while females with HIV were more vulnerable to functional limitation and disabilities. HIV infection was associated with higher odds for 3 of the 6 healthspan-related indicators after fully adjusted, such as physical frailty and depression. Sensitivity analyses did not change the health differences between adults with and without HIV infection.

CONCLUSIONS

In a large sample of U.S. community-dwelling adults, by identifying the extent and pattern of health disparities, we characterized the multi-dimentional health of PWHs, providing important public health implications for public policy that aims to improve health of persons with HIV and further reduce these disparities.

Prevalence and functional impact of parkinsonian signs in older adults from the Good Aging in Skåne study

INTRODUCTION

Mild parkinsonian signs (MPS) have been characterized by several definitions, using the motor part of the Unified Parkinson's Disease Rating Scale (UPDRS). We aimed to investigate the prevalence of MPS and their association with functional level and comorbidities in the oldest old.

METHOD

Community-dwelling older adults (n = 559, median age 85, range 80-102 years) were examined regarding MPS, possible parkinsonism (PP) and subthreshold parkinsonism (SP) according to four previously used definitions and concerning the impact of parkinsonian signs on cognitive, physical, and autonomic function. MPS, PP and SP are different terms describing a very similar phenomenon and there is no gradation between these. In two of the four definitions more advanced symptoms were categorized as parkinsonism.

RESULTS

Median UPDRS score in the whole study group was 10 points (range: 0-58) and was predominated by bradykinesia. MPS/PP/SP were present in 17-85%, and parkinsonism in 33-71% of the cohort. Independently of age and gender, MPS/PP/SP and especially parkinsonism, were associated with a higher risk of fear of falling and accomplished falls, with lower: cognition, ADL, physical activity and quality of life, and with urinary incontinence, obstipation and orthostatic intolerance.

CONCLUSIONS

In a population of older adults above 80 years, MPS are highly prevalent as well as more advanced symptoms defined as parkinsonism, and only 9-17% of the cohort is symptom-free. Predominance of bradykinesia in the oldest old might indicate a need for revision of MPS definitions to improve their sensibility.

Spinal pseudoarthrosis following osteoporotic vertebral fracture: prevalence, risk factors, and influence on patients' activities of daily living 1 year after injury

PURPOSE

To investigate the prevalence and risk factors and influence of pseudoarthrosis on activities of daily living (ADL) of patients with osteoporotic vertebral fracture (OVF).

METHODS

Spinal pseudoarthrosis is defined as the presence of a cleft in the vertebral body on a lateral X-ray image in the sitting position at 1 year after admission. Of the total 684 patients treated for OVF between January 2012 and February 2019 at our institution, 551 patients (mean age, 81.9 years; a male-to-female ratio, 152:399) who could be followed up to 1 year were included in this study. Prevalence, risk factors, and influence of pseudoarthrosis on the ADL of patients as well as fracture type and location were investigated. Pseudoarthrosis was set as the objective variable. Total bone mineral density, skeletal muscle mass index, sex, age, history of osteoporosis treatment, presence of dementia, vertebral kyphosis angle, fracture type (presence of posterior wall injury), degree of independence before admission, history of steroid use, albumin level, renal function, presence of diabetes, and diffuse idiopathic skeletal hyperostosis were set as explanatory variables for multivariate analysis of the influence of pseudoarthrosis on the walking ability and ADL independence before and 1 year after OVF.

RESULTS

In total, 54 (9.8%) patients were diagnosed with pseudarthrosis 1 year after injury (mean age, 81.3 ± 6.5 years; male-to-female ratio, 18:36). BKP was performed in nine patients who did not develop pseudoarthrosis after 1 year. In the multivariate analysis, only the presence of posterior wall injury was significantly correlated with the presence of pseudoarthrosis (OR = 2.059, p = 0.039). No significant difference was found between the pseudarthrosis group and the non-pseudarthrosis group in terms of walking ability and ADL independence at 1 year.

CONCLUSIONS

The prevalence of pseudoarthrosis following OVF was 9.8%, and its risk factor was posterior wall injury. The BKP group was not included in the pseudoarthrosis group, which may have led to an underestimation of the prevalence of pseudoarthrosis. The prevalence, risk factors, and influence of spinal pseudoarthrosis on patients' ADL following osteoporotic vertebral fracture (OVF) were investigated. Pseudoarthrosis occurs in 9.8% 1 year after the injury in patients with OVF. Posterior wall injury was the risk factor of pseudoarthrosis.

Development of a UK core dataset for geriatric medicine research: a position statement and results from a Delphi consensus process

BACKGROUND

There is lack of standardisation in assessment tools used in geriatric medicine research, which makes pooling of data and cross-study comparisons difficult.

METHODS

We conducted a modified Delphi process to establish measures to be included within core and extended datasets for geriatric medicine research in the United Kingdom (UK). This included three complete questionnaire rounds, and one consensus meeting. Participants were selected from attendance at the NIHR Newcastle Biomedical Research Centre meeting, May 2019, and academic geriatric medicine e-mailing lists. Literature review was used to develop the initial questionnaire, with all responses then included in the second questionnaire. The third questionnaire used refined options from the second questionnaire with response ranking.

RESULTS

Ninety-eight responses were obtained across all questionnaire rounds (Initial: 19, Second: 21, Third: 58) from experienced and early career researchers in geriatric medicine. The initial questionnaire included 18 questions with short text responses, including one question for responders to suggest additional items. Twenty-six questions were included in the second questionnaire, with 108 within category options. The third questionnaire included three ranking, seven final agreement, and four binary option questions. Results were discussed at the consensus meeting. In our position statement, the final consensus dataset includes six core domains: demographics (age, gender, ethnicity, socioeconomic status), specified morbidities, functional ability (Barthel and/or Nottingham Extended Activities of Daily Living), Clinical Frailty Scale (CFS), cognition, and patient-reported outcome measures (dependent on research question). We also propose how additional variables should be measured within an extended dataset.

CONCLUSIONS

Our core and extended datasets represent current consensus opinion of academic geriatric medicine clinicians across the UK. We consider the development and further use of these datasets will strengthen collaboration between researchers and academic institutions.

Effects of dementia special care unit on changes of physical function, cognitive function, and problematic behavior among nursing home residents

Background

This study compared changes in physical function, cognitive function, and problematic behaviors among nursing home residents with dementia between the dementia specialized care and general units.

Methods

To assess the effects of a dementia specialized care unit (D-SCU), this study applied the difference-in-differences method. While the D-SCU was introduced in July 2016, the service was provided in January 2017. We defined the pre-intervention period as July 2015 to December 2016 and the post-intervention period as January 2017 to September 2018. We matched long-term care insurance beneficiaries using the propensity score matching method to minimize selection bias. After this matching, two new groups were obtained, each with 284 beneficiaries. To characterize the actual effects of the D-SCU on physical function, cognitive function, and problematic behaviors among dementia beneficiaries, we conducted a multiple regression analysis that controlled for demographics, LTC need, and LTC benefit utilization.

Results

The physical function score significantly increased according to the time effect, and the interaction term between time and the use of D-SCU was significant. Therefore, the activities of daily living (ADL) score of the control group increased by 5.01 points more than that in the group of beneficiaries using the D-SCU (p<0.001). However, the interaction term had no significant effect on cognitive function or problematic behavior.

Conclusion

These results revealed the partial effect of the D-SCU on long-term care insurance. Further research is required that considers the variables of service providers.

Multidomain cognitive training increases physical activity in people with Parkinson's disease with mild cognitive impairment

INTRODUCTION

Cognitive impairment in Parkinson's disease (PD), especially in patients with mild cognitive impairment (PD-MCI), coincides with less physical activity. Cognitive trainings (CT) have been found to promote laboratory environment-based movement. Knowledge about their effect in natural home-based environment, reflecting everyday function, is sparse. This explorative study investigated short-term effects of CT on physical activity assessed by home-based accelerometry, and its relation to change of cognitive function over time and non-cognitive outcomes in patients with PD-MCI. Cognitive and non-cognitive correlates of movement parameters at pretest were evaluated as well.

METHODS

Eighteen patients with PD-MCI of the TrainParC study were analyzed. Those patients received either a 6-week multidomain group CT or physical training (PT). Physical activity and sedentary behavior were assessed with wearable accelerometers worn up to seven days pre- and post-training.

RESULTS

Patients in the CT group displayed significantly greater increases in active periods after training than patients assigned to PT. In the CT group, increases in executive functioning were associated with increases in active periods and decreases in active mean bout length after training. At pretest, reduced working memory correlated with longer sedentary mean bout length, and impairment in activities of daily living (ADL) correlated with a higher number of sedentary periods.

CONCLUSION

Study data revealed that CT can increase physical activity in patients with PD-MCI, possibly due to effects on executive functions, which needs further investigation in larger sample sizes. Lower working memory performance and ADL impairment might be associated with a more inactive lifestyle in patients with PD-MCI.

Total Talar Replacement for Idiopathic Osteonecrosis of the Talus: Investigation of Clinical Outcomes, Pain, ADL, QOL

Background

Treatment of osteonecrosis of the talus is challenging. Nonoperative management includes nonweightbearing treatment. Various types of hindfoot fusion procedures have been performed, but delayed union and shortening of the operated leg have reportedly occurred. In contrast, talar body prosthesis is a surgical procedure with potential that relieves pain, restores ankle joint function, and is not associated with leg-length discrepancy. The aim of this study was to investigate postoperative pain, clinical outcomes, activities of daily living (ADL), and quality of life (QOL) after total talar replacement in patients with osteonecrosis of the talus.

Methods

Ten ankles in 10 patients with idiopathic osteonecrosis of the talus who were treated with a total talar replacement between 2007 and 2015 were included in the investigation. Scores according to the visual analog scale (VAS), Japanese Society for Surgery of the Foot (JSSF) ankle-hindfoot scale, Functional Independence Measure (FIM), and the Self-Administered Foot Evaluation Questionnaire (SAFE-Q) were assessed.

Results

The VAS score significantly improved from a mean of 80 ± 8 points before surgery to 18 ± 22 points after surgery (P < .01). The JSSF ankle-hindfoot scale score significantly improved from a mean of 53 ± 12 points before surgery to 89 ± 7 points after surgery (P < .01). The FIM score significantly improved from a mean of 122 ± 1 points before surgery to 125 ± 1 points after surgery (P < .01). The mean postoperative SAFE-Q scores were as follows: 81 ± 10.3 points for pain, 78 ± 14.7 points for physical function, 90 ± 12.4 points for social function, and 83 ± 15.4 points for shoe-related.

Conclusion

Total talar replacement is a useful treatment for patients with osteonecrosis of the talus. This replacement surgery preserves the function of the ankle and subtalar joints, and improves pain, ADL, and QOL.

Level of Evidence

Level IV, case series.

Association between volume of patients undergoing stroke rehabilitation at acute care hospitals and improvement in activities of daily living

BACKGROUND

This study aimed to determine the relationship between the annual volume of patients undergoing rehabilitation per hospital and the outcomes of patients admitted for acute stroke.

METHODS

This observational study used nationwide administrative data. Data on stroke patients aged ≥ 20 years who underwent rehabilitation were extracted from 1,182 acute care hospitals in Japan. The exclusion criteria were extended hospital stay exceeding 180 days and death during hospitalization. Hospital volumes were divided into four quartiles of total patients per hospital. The primary outcome was an improvement in activities of daily living from admission to discharge measured using the Barthel index. Poisson regression analysis of activities of daily living improvement was performed using inverse probability of treatment weighting.

RESULTS

High rehabilitation volume was significantly correlated with improvements in activities of daily living using the "very low group" as a reference (risk ratio [95% confidence interval]): 1.06 [1.05-1.08], P<0.001). Low volume was also significantly associated with activities of daily living improvement (risk ratio [95% confidence interval]: 1.04 [1.03-1.06], P<0.001).

CONCLUSIONS

The annual volume of stroke patients undergoing multidisciplinary rehabilitation at a specific hospital may be a factor in the degree of patient improvement in activities of daily living.

Caregiving to Older Adults With a Physical Limitation: Evidence From the Mexican Health and Aging Study

Background and Objectives

Many older adults face physical limitations to performing activities of daily life (ADLs) and instrumental activities of daily life (IADLs) and seek help performing them. In Mexico, family caregivers, especially spouses and adult children, traditionally take care of older adults. However, a detailed characterization of the care received has not been thoroughly provided. We sought to identify socioeconomic, demographic, and health-related differences in receiving help among older adults reporting physical limitations.

Research Design and Methods

Using the 2012 wave of the Mexican Health and Aging Study, we provided information on adults aged 60 and older who reported one or more physical limitations and whether they received help or not. We estimated 2 logistic regression models to obtain the odds ratios (ORs) of receiving help among individuals with an ADL limitation and those with an IADL limitation.

Results

Adults with ADL limitations received, on average, approximately 10.7 hr of assistance per day, whereas those with at least 1 IADL limitation received around 7.7 hr of help per day. Women were more likely to receive help with ADLs than men (OR = 2.35). Individuals with chronic conditions such as hypertension, diabetes, and arthritis also received more help with both ADLs and IADLs.

Discussion and Implications

Our work suggests that help received does respond to the care needs of older adults, but future research should focus on the burden of care for caregivers and expand this analysis using a longitudinal data approach.

A self-supervised algorithm to detect signs of social isolation in the elderly from daily activity sequences

Considering the increasing aging of the population, multi-device monitoring of the activities of daily living (ADL) of older people becomes crucial to support independent living and early detection of symptoms of mental illnesses, such as depression and Alzheimer's disease. Anomalies can anticipate the diagnosis of these pathologies in the patient's normal behavior, such as reduced hygiene, changes in sleep habits, and fewer social interactions. These abnormalities are often subtle and hard to detect. Especially using non-intrusive monitoring devices might cause anomaly detectors to generate false alarms or ignore relevant clues. This limitation may hinder their usage by caregivers. Furthermore, the notion of abnormality here is context and patient-dependent, thus requiring untrained approaches. To reduce these problems, we propose a self-supervised model for multi-sensor time series signals based on Hyperbolic uncertainty for Anomaly Detection, which we dub HypAD. HypAD estimates uncertainty end-to-end, thanks to hyperbolic neural networks, and integrates it into the "classic" notion of reconstruction loss in anomaly detection. Based on hyperbolic uncertainty, HypAD introduces the principle of a detectable anomaly. HypAD assesses whether it is sure about the input signal and fails to reconstruct it because it is anomalous or whether the high reconstruction loss is due to the model uncertainty, e.g., a complex but regular signal (cf. this parallels the residual model error upon training). The proposed solution has been incorporated into an end-to-end ADL monitoring system for elderly patients in retirement homes, developed within a funded project leveraging an interdisciplinary consortium of computer scientists, engineers, and geriatricians. Healthcare professionals were involved in the design and verification process to foster trust in the system. In addition, the system has been equipped with explainability features.

Environment Intensifies Imbalance and Fear of Falling: Comparing Urban and Rural Aging Communities

BACKGROUND

The relationship between environmental diversity and the health status of older adults has been less considered in studies. This study seeks to investigate the causal relationship among the environment, falling, fear of falling, and the imbalance of older adults in southern Iran in 2021.

OBJECTIVE

The investigation into the relationship between environmental pollution to the imbalance and fear of falling, especially in comparing urban and rural aging societies is the aim of current study.

METHODS

In a cross-sectional study, 489 older samples from rural and urban areas were chosen randomly and their experience of falling, fear of falling, imbalance, and IADL were examined. The ordinal and nominal logistic regression and ANOVA were performed using IBM-SPSS.

RESULTS

With a mean age of 71.8 (SD = 8.3), older participants have long time chronic disease (69.6%) and falling experience twice a year (42.7%). The values of effect size indicated the high effectiveness of settlement in explaining IADL, health situation, experience and fear of falling, and imbalance (Eta squared > 30). The odds ratio for being in the urban settlement was 5.51, indicating the imbalance score increased by approximately 5.52 times.

CONCLUSION

Imbalance in older people leads to the fear and experience of falling. This imbalance is strongly influenced by the environment. Urban pollution can contribute to this problem. Future studies on aging need to focus on environmental pollution and diversity in the experience of falling and imbalance.

Predictors and preventers of postoperative bedridden status in the elderly ages over 75 after emergency general surgery: a retrospective cohort study

Aim

We investigated the proportion of bedridden patients after emergency surgery among the elderly ages over 75; defined as the latter-stage elderly in Japan, the associated factors, and interventions used to prevent it.

Methods

Eighty-two latter-stage elderly patients who underwent emergency surgery for non-traumatic illness between January 2020 and June 2021 in our hospital were included in the study. Backgrounds and various perioperative factors were compared retrospectively between the groups including patients who became bedridden from Performance Status Scale 0 to 3 before admission (Bedridden group) and those who did not (Keep group).

Results

Three cases of death and seven patients who were bedridden before admission were excluded. The 72 remaining patients were divided into the Bedridden group (n = 10, 13.9%) and the Keep group (n = 62, 86.1%). There were significant differences in the prevalence of dementia, pre- and postoperative circulatory dynamics, renal dysfunction, coagulation abnormality, length of stay in the high care unit/intensive care unit, and number of hospital days, with a relative risk of 13 (1.74-96.71), a sensitivity of 1.00, and a specificity of 0.67 for a preoperative shock index of 0.7 or higher being associated with the Bedridden group. Among patients with a preoperative shock index of 0.7 or higher, there was a significant difference in SI at 24 h postoperatively between the two groups.

Conclusion

Preoperative shock index may be the most sensitive predictor. Early circulatory stabilization seems to be protective against patients becoming bedridden.

The aging mind: A complex challenge for research and practice

Cognitive decline as part of mental ageing is typically assessed with standardized tests; below-average performance in such tests is used as an indicator for pathological cognitive aging. In addition, morphological and functional changes in the brain are used as parameters for age-related pathological decline in cognitive abilities. However, there is no simple link between the trajectories of changes in cognition and morphological or functional changes in the brain. Furthermore, below-average test performance does not necessarily mean a significant impairment in everyday activities. It therefore appears crucial to record individual everyday tasks and their cognitive (and other) requirements in functional terms. This would also allow reliable assessment of the ecological validity of existing and insufficient cognitive skills. Understanding and dealing with the phenomena and consequences of mental aging does of course not only depend on cognition. Motivation and emotions as well personal meaning of life and life satisfaction play an equally important role. This means, however, that cognition represents only one, albeit important, aspect of mental aging. Furthermore, creating and development of proper assessment tools for functional cognition is important. In this contribution we would like to discuss some aspects that we consider relevant for a holistic view of the aging mind and promote a strengthening of a multidisciplinary approach with close cooperation between all basic and applied sciences involved in aging research, a quick translation of the research results into practice, and a close cooperation between all disciplines and professions who advise and support older people.

Strengthening problem-solving skills through occupational therapy to improve older adults' occupational performance - A systematic review

Background: Evidence supports the role of occupational therapy (OT) for older adults, and therapeutic use of problem solving may provide a way to improve older adult's occupational performance.Aim: To assess the effectiveness and describe the contents of OT interventions aimed at improving older adults' occupational performance by strengthening their problem-solving skills.Material and Methods: This systematic review followed the phases recommended by the Cochrane Collaboration. The following databases were searched for clinical trials on OT for populations 65+ years: CINAHL, EMBASE, MEDLINE and PsycINFO. The Cochrane risk-of-bias tool (RoB-2) and the GRADE approach were used to assess the quality of the evidence. Results were presented in tables and by narrative syntheses.Results: Five studies were included comprising a total of 685 participants. In four studies, OT with a problem-solving approach outperformed control conditions post intervention. The interventions involved problem identification, analysis, strategy development and implementation. Although no serious risk of bias was detected in the individual studies, the quality of evidence was deemed low due to inconsistent and imprecise results.Conclusions: Low-quality evidence suggests that strengthening older adults' problem-solving skills may improve their occupational performance.Significance: Further investigation is required before firm practice recommendations can be prepared.

Clinical Advantage of Attaining Index-Based Remission Prior to Composite Remission in Treating Rheumatoid Arthritis

BACKGROUND AND OBJECTIVES

The clinical advantage of targeting index-based remission prior to Boolean remission was evaluated retrospectively.

MATERIALS AND METHODS

A total of 578 patients with rheumatoid arthritis (RA), who were treated for more than three years, were recruited. Patients who were treated to targeted index-based remission and composite measure remission criteria such as Boolean remission from the first consultation were divided according to the turn of attaining Boolean remission and index-based remission: G-IBR, a group that matched index-based remission at the same time Boolean remission is attained or earlier; G-BR_IF, a group that attained Boolean remission followed by index-based remission or failed; G-IR_BF, a group that could not attain Boolean remission despite attaining index-based remission; G-BothF, a group that failed to attain either Boolean remission or index-based remission. Background factors were statistically compared among groups. The Boolean remission rate in patients who attained index-based remission (BRR) and the rate of failure to attain index-based remission in patients who failed to attain Boolean remission (BFR) were statistically evaluated.

RESULTS

Groups comprising 225, 231, and 482 in G-IBR; 160, 154, and 8 in G-BR_IF; 18, 18, and 75 in G-IR_BF; and 175, 175, and 13 in G-BothF when indexing the clinical disease activity index (CDAI), simplified disease activity index (SDAI), and 28-joints disease activity score with C-reactive protein (DAS28-CRP), respectively. Disease activity indices' scores after Boolean remission were demonstrated to be significantly higher in the G-BR_IF group than in the G-IBR group. BRR was 92.6%, 92.8%, and 86.5%, while BFR was 71.3%, 71.3%, and 13.8% when indexing CDAI, SDAI, and DAS28-CRP, respectively.

CONCLUSIONS

Targeting CDAI and SDAI remission prior to Boolean remission contributes to a stable clinical course.

Multivariate analysis of independent determinants of ADL/IADL and quality of life in the elderly

BACKGROUND

This study evaluated the determinants of disability and quality of life in elderly people who participated at the multi-centred RubiN project (Regional ununterbrochen betreut im Netz) in Germany.

METHODS

Baseline data of the subjects aged 70 years and older of the RubiN project were used and only subjects with complete data sets were considered for the ensuing analysis (complete case analysis (CCA)). Disability was examined using the concepts of ADL (activities of daily living) and IADL (instrumental activities of daily living). Subjects exhibiting one or more deficiencies in ADL respectively IADL were considered as ADL respectively IADL disabled. Quality of life was assessed using the WHOQOL-BREF and the WHOQOL-OLD. Applying multivariate analysis, sociodemographic factors, psychosocial characteristics as well as the functional, nutritional and cognitive status were explored as potential determinants of disability and quality of life in the elderly.

RESULTS

One thousand three hundred seventy-five subjects from the RubiN project exhibited data completeness regarding baseline data. ADL and IADL disability were both associated with the respective other construct of disability, sex, a reduced cognitive and functional status as well as domains of the WHOQOL-BREF. Furthermore, ADL disability was related to social participation, while IADL disability was linked to age, education and social support. Sex, ADL and IADL disability, income, social support and social participation as well as the functional status were predictors of the domain 'Physical Health' (WHOQOL-BREF). The facet 'Social Participation' (WHOQOL-OLD) was affected by both ADL and IADL disability, income, social participation, the nutritional and also the functional status.

CONCLUSIONS

Several potential determinants of disability and quality of life were identified and confirmed in this study. Attention should be drawn to prevention schemes as many of these determinants appear to be at least partly modifiable.

Application of Exploratory Factor Analysis and Item Response Theory to Validate NHANES ADL Scale in Patients Reporting Rheumatoid Arthritis

Background: Several instruments are used for measuring functional limitations among rheumatoid arthritis (RA) patients. However, these instruments are incongruously assessed for their psychometric properties. The National Health and Nutritional Examination Survey (NHANES) uses a generic questionnaire to assess the activities of daily living (ADL) to measure functional limitations among its participants. The psychometric properties of the NHANES-ADL scale were evaluated using a patient examination and survey data. Methods: NHANES-ADL scale was assessed for its internal consistency and factor structure. Scale reliability was assessed with Cronbach's alpha reliability coefficient. Principal component analysis with Promax rotation was used to obtain factor structure. Confirmatory factory analysis was used to calculate fit indices. The graded item response theory model was used to estimate item discrimination, difficulty, and test information. Results: Our sample included 1132 individuals with RA. Exploratory factor analyses of 19-item NHANES ADL scale produced one factor solution and accounted for 35% of variance. The Cronbach alpha of this scale was 0.92. The results of graded item response model indicated items performing well discriminating high and low level of functional ability. A higher slope (α) reflected stronger ability of items to discriminate across the continuum. Conclusions: The NHANES ADL scale showed good reliability, single dimensionality, and validity in RA patients. Studies should explore its test-retest reliability and its ability to reliably measure functional change over time in the future.

Association of Number of Teeth with ADL/IADL in Korean Middle-Aged and Older Adults: An Analysis of the 7th Korean Longitudinal Study of Aging

We determined the association between the number of natural and implant teeth with activities of daily living (ADL) and instrumental ADL (IADL) levels in middle-aged and older adults aged ≥ 55 years. We included 6,925 participants, who underwent a computer-assisted personal interview in the 7th Korean Longitudinal Study of Aging. After controlling for general characteristics, the associations between the number of natural and implant teeth with ADL and IADL levels were examined using multiple regression analysis. The participants had 21.2 natural teeth and 1.08 implant teeth on average. The ADL and IADL levels were 0.61 and 1.56, 0.40 and 1.16, and 1.10 and 0.31 in participants with ≤ 9, 10-19, and ≥ 20 teeth, respectively. There was no significant association between ADL and the number of natural and implant teeth (p > 0.05). However, a one-unit increase in IADL score was associated with a reduced number of natural (β = -0.031, p < 0.001) and implant (β = -0.194, p = 0.006) teeth. Difficulties regarding IADL were associated with fewer natural and implant teeth, suggesting that maintaining and managing the number of teeth is critical to promoting the health of middle-aged and older adults.